Reimbursement Manager
Lehigh Valley Health Network
Summary
Interprets Medicare and Medicaid regulation and direct hospital activities to comply with government payment regulation and optimize Medicare and Medicaid revenue. Develops and executes processes necessary to gather information required for completion of the Medicare and Medicaid cost reports and is responsible to complete the cost reports accurately and by the filing due dates.
Job description
Job Duties
- Calculates the financial impacts of purchasing, readmissions, hospital acquired infections, and accountable care arrangements.
- Develops strategies and implement processes to ensure the hospital is in compliance with Medicare and Medicaid regulation.
- Develops processes needed to complete cost reports and ensure the hospital is paid for all programs and services.
- Provides expert guidance on complying with Medicare and Medicaid reimbursement and payment regulation.
- Provides expert advice to identify opportunities to achieve reimbursement for all programs and services provided.
- Provides support for participation in cost report appeals and cost report group appeals.
- Evaluates firms organizing group appeals and recommend firms and consultants to use in preparing and follow appeals.
- Supports the revenue budget process for items where reimbursement is calculated on the cost report.
- Reviews third party settlements monthly and updates in accordance with the monthly and fiscal year end closing schedules.
Minimum Qualifications
- Bachelor's Degree
- 5 years Interpreting Medicare and Medicaid payment regulation and completing Medicare and Medicaid cost reports.
- 5 years Recording revenue and determining cost settlement receivables/payables for Medicare and Medicaid payments
- Ability to work independently.
Requirements
- Bachelor's Degree
- 5 years interpreting Medicare and Medicaid payment regulation and completing Medicare and Medicaid cost reports
- 5 years recording revenue and determining cost settlement receivables/payables for Medicare and Medicaid payments
- Ability to work independently
Company overview
Lehigh Valley Health Network (LVHN) is a major healthcare provider and hospital network based in Allentown, Pennsylvania, serving the Lehigh Valley and Northeastern Pennsylvania regions. Founded in 1899, LVHN operates as a comprehensive healthcare system with 13 hospital campuses, 28 health centers, numerous primary and specialty care physician practices, and multiple urgent care locations. The network's flagship facility, Lehigh Valley Hospital-Cedar Crest, is Pennsylvania's third-largest hospital and features the state's first Level One Trauma Center. LVHN provides a wide range of medical services including specialized institutes for cancer care, heart and vascular treatment, surgical excellence, orthopedics, and neuroscience. The network operates the third-largest heart surgery program in Pennsylvania, performing over 1,200 open-heart procedures annually, and maintains one of the state's largest cancer centers treating over 2,400 new patients each year. In August 2024, LVHN completed a merger with Jefferson Health, becoming part of a larger healthcare system with 32 hospitals and over 700 locations across Pennsylvania. Prior to the merger, LVHN was the largest employer in the Lehigh Valley metropolitan region, with approximately 20,000 employees dedicated to providing comprehensive healthcare services to the community.